The invention generally relates to bone fracture reduction and fixation and more particularly to a cannulated, internally threaded bone screw and a reduction driving device and a method of using the same to effect the reduction and fixation of bone fractures.
It is known to use screw-type devices and associated drivers for bone fracture repair. These screw-type devices may be used in combination with clamps to achieve bone fracture fixation. As one example of same, U.S. Pat. No. 5,498,265 issued Mar. 12, 1996 discloses a bone screw and a driver for driving the screw into a fracture site. The bone screw has a threaded shank having proximal and distal externally threaded shank portions and an internally threaded head sleeve portion which receives the threaded rod of the driver. The driver has a handle and an inner rod connected to the handle. The rod fits within the head sleeve and mates with a cutout in the proximal end of the threaded shank portion. After the screw is placed in a fractured bone, the length of the screw can be adjusted longitudinally to compress the fracture.
U.S. Pat. No. 2,243,717, issued May 27, 1941, for a surgical device shows a cannulated bone screw having a threaded end, a square shaft portion, a round shaft portion and a screw portion. A clamp formed with a head and skirt has a bore allowing it to be mounted on the threaded end. A nut is threadedly mounted on the threaded end of the bone screw. When the bone screw is used in fracture repair, the fracture site is drilled to form a bore and the screw portion of the bone screw is screwed into the bone bore using wrench members specially adapted to drive the bone screw. When the bone screw is firmly anchored in the bone, the guide wire previously inserted is withdrawn, the clamp is applied to the threaded end of the bone screw, and the nut is caused to engage the threaded end. Tightening the nut moves the clamp towards the screw portion to fix the fracture.
An example of a similar screw type device, the length of which can be adjusted to compress a fracture site can be found in U.S. Pat. No. 2,121,717 issued Jun. 2, 1930. U.S. Pat. No. 4,858,601, issued Aug. 22, 1989, is also directed toward a adjustable length screw in the form of a sectioned bone screw which is cannulated and threaded on its outer surface. The bone sections are held together by a spindle received in the cannula and soldered to a section.
Screw-type devices which are used in combination with external clamping means to achieve bone fracture reduction and fixation are also known. U.S. Pat. No. 5,690,633, issued Nov. 25, 1997, shows a fracture fixation device which combines the functions of external fixation pins and external fixation or xe2x80x9clag-typexe2x80x9d screws in a single unit. The fracture fixation device includes cannulated screw means for screwing into a first bone fragment over a guide pin and engagement means in the form of a collar mounted on a rod for engaging a second bone fragment. The screw means and engagement means coact to compress first and second bone fragments. Attachment means preferably integral with the screw means has an outer end for attachment to an external fixator system which includes an elongated external fixator rod and at least a pair of external fixator connectors attached to the rod at spaced locations.
Further examples of external fixation devices and clamps can be found in U.S. Pat. No. 1,789,060, issued Jan. 13, 1931, and U.S. Pat. No. 4,360,012, issued Nov. 23, 1982.
A screw and driver for securing a bone block is disclosed in U.S. Pat. No. 5,423,819, issued Jun. 13, 1995. The screw and driver are both rotationally and axially releaseably coupled so the screw can be inserted in a downwardly facing hole. The screw is preferably threaded along its entire exterior surface length and has a blind bore which opens on the proximal end of the screw. A driver with an elongated shaft is inserted into a counterbore portion of the axial blind bore of the screw so that the front portion will compress radially. When the front portion is fully inserted, it snugly engages the wall of the bore with a minor spring biased interference so that the driver is releasably coupled to the screw. The driver also includes an elongate intermediate portion having a hexagonal cross-section and the counterbore of the screw is provided with a complimentary hexagonal cross-sectional configuration so that rotation of the intermediate portion causes rotation of the screw. In one embodiment of the screw and driver, a throughgoing axially aligned bore is provided in both the screw and the driver to accommodate a K-wire allowing the screw to slide freely along the wire.
U.S. Pat. No. 5,431,651, issued Jul. 11, 1995, shows a cross pin and set screw femoral and tibial fixation apparatus and method for mounting a ligament graft. The patent is directed towards an arthroscopic surgical procedure for replacement of a cruciate ligament in a knee and requires fixation of the ends of a ligament in a prepared tunnel. Transverse holes are drilled in the femoral tunnel during the procedure preferably using a drill guide. The apparatus includes a drill guide for drilling the transverse hole or holes which is arranged to be releasable from a first twist drill so that the first twist drill is left in place to be used for guiding further drilling and for passage of a fastener device. A K-wire or the first twist drill that has been left in place is then used for guiding a second twist drill for enlarging the transverse hole and for guiding a cannulated screw fastener device in the femoral bone end of a ligament graft that has been fitted in to the femoral tunnel section. A set screw is mounted on a forward end of a turning tool and the turning tool and set screw are cannulated to receive a K-wire. A coupling end of the turning tool is seated in a rear end recess in the set screw to mount the screw on the turning tool so that the turning tool and set screw are rotatably coupled but not axially coupled.
A cannulated bone screw is shown in U.S. Pat. No. 4,950,270, issued Aug. 21, 1990. The bone screw has an axial cannula suitable for use with a guide pin for positioning the screw in a bore. The screw is provided with an exterior screw thread having a normal helical winding for screwing insertion of the screw into a bone material. The external threading extends the length of the screw to facilitate the complete insertion of the same in the bone.
A cannulated screw and driver used in bone marrow harvesting and bone biopsy systems is shown in U.S. Pat. No. 5,456,267, issued Oct. 10, 1995. The cannulated screw has a torque receiving head and threaded shaft exterior with one embodiment including inner threads which terminate a hexagonal shaped interior portion. The head is provided with a hexagonal shaped interior portion to permit engagement with a driving tool. The screw includes a structure on one end permitting attachment of a fitting for applying negative pressure to facilitate marrow harvesting. The embodiment includes inner threads on a first end, or in the alternative, pressure fittings or twist lock fittings may be provided. The threads or other structures must provide sufficient seal to permit the negative pressure required for harvesting.
An examination of the prior art indicates the need for a fracture reduction bone screw that provides an attachment site for a bone screw driving device so that the bone screw and driving device cooperate to form an assembly which can be manually manipulated to effect fracture reduction and provide structural support for conventional clamping devices to effect bone fracture fixation.
The present invention discloses and describes a cannulated, externally and internally threaded bone screw and a driving device for same for use in the reduction and fixation of bone fractures. The head of the screw is shaped to conform to the end portion of the driving device and may be of various shapes and sizes.
The internal threading allows the bone screw to be used in a wide range of orthopedic applications. For example, the internal threading can serve as an attachment site for the driving device or may be used for fixation of orthopedic equipment such as bone plates, rods or other types of screws.
In the driving device, a distally threaded rod member and a releasable lockable cap member are used to secure an internally threaded bone screw to the distal end of the cannulated bone screw driving device. After the bone screw is driven into a bone, a bone fixation and reduction unit can be constructed by securing the bone screw to the driver device by threading an end of the rod member with the internal threading of the bone screw and rotating the cap member mounted on the proximal end of the rod member to tighten the engagement.
Because the screw is secured to the driver device by a threaded rod and because the bone screw is constructed of high grade surgical steel with machined external and internal threading, considerable force can be applied to the unit to align the bone, reduce the bone fracture and apply traction to the fracture site. The driver can be quickly detached from the screw by manually rotating the cap member to disengage the rod from the internal screw threading. This allows the bone screw and driving device to be used in a wide range of orthopedic applications. The bone screw and driving device can also be used in various ways with conventional bone plates.
The reduction and fixation assembly can be used alone or with other assemblies to align and reduce fractures. The assemblies may, for example, be secured to fractured bone sections in pairs with one assembly on each side of the fracture site, and manually manipulated to reduce the fracture. Following fracture reduction, the driving devices can be easily removed by manually manipulating the cap member, leaving the bone screw in place or the assemblies themselves may be used as external fracture fixation devices. For example, once the fracture is reduced, a handle portion of the driving device may be removed and conventional cross bars or other clamping devices may be attached between shaft portions of the assemblies to convert the assemblies into an external fixator device to effect fracture fixation.
In a first example of the use of a bone plate with the bone screw and driving device, a plurality of bone screws are driven with a first driving device into a fractured bone through the apertures in a bone plate. A plurality of driving devices are secured to bone screws on opposite sides of the fracture with respective threaded rods to provide reduction and fixation assemblies on each side of the fracture site to effect fracture alignment and reduction. Following fracture alignment and reduction, the bone screws can be tightened to hold the plate in place for fracture fixation and the driving devices are removed leaving the bone screws in the bone.
In a second example using a bone plate with the bone screw and driving device, a plurality of bone screws can be driven with a driving device into a fractured bone in alignment to receive the apertures in a bone plate and support the same. After fracture reduction with a pair of reduction and fixation assemblies, a conventional bone plate can be applied to the fracture site by mounting the plate on the aligned internally threaded bone screws with a second set of conventional screws which extend through the apertures in the bone plate and threadedly engage the internal threading of the bone screws. The head portions of the bone screws can thus be used to support a conventional bone plate or other conventional orthopedic equipment and the internally threaded cannula of each screw can receive and threadedly engage a conventional second screw to secure the bone plate or other structure to the fracture site.
Yet another object of the invention is to provide a bone screw-driver assembly of simple construction which can be used to apply traction to the fracture site.
It is an object of the invention to provide a self-drilling, self-tapping cannulated bone screw that is both externally and internally threaded. The internal threading can advantageously provide an attachment site for a reduction screw driving device that can be used to drive the internally threaded bone screws into bony tissue including cortical or cancellous bone during orthopedic surgical procedures.
It is a further object of the present invention to provide an internally threaded bone screw that can be used for bone reduction and fixation of fractured bones, for the fixation of orthopedic equipment such as plates, rods to bone, particularly fractured bone, or for the fixation of other types of screws in orthopedic procedures.
It is a further object of the invention to provide a rod member that is threaded at a distal end and cap member that is releaseably locked to a proximal end of the rod member to provide torque to the rod member.
It is also an object of the invention use the rod member and cap member to adapt a cannulated screwdriver, and a cannulated, internally threaded bone screw to construct a bone fixation and reduction assembly.
Another object of this invention is to use the bone screw driver assembly to align and reduce fractures.
Yet another object of this invention is to describe a plurality of methods for using the bone screw-driver assembly during surgical procedures following fracture alignment and reduction to effect bone fracture fixation.
It is a further object of this invention to show how a plurality of the assemblies can be used for fixation of fractures using external support structures; and to show how a driving device can be easily removed from an assembly once the bone screw is in place and the screw can be used for the application of a surgical plate to the fracture site.
These and other objects, advantages, and novel features of the present invention will become apparent when considered with the teaching contained in the detailed disclosure along with the accompanying drawings.